Financial Coordinator

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Job description

Financial Care Coordinator

GENERAL SUMMARY/ OVERVIEW STATEMENT:

The Financial Care Coordinator (FCC) is a non-clinical staff member of the Centralized Authorization Unit. This individual is part of an integrated care team that focuses on coordinating the financial aspect to patient care. The coordinator will work with patients and their families, beginning with an initial evaluation of insurance eligibility, coverage for treatment plan, financial liabilities, and prescription benefit coverage. The FCC will assist patients throughout their care in their dedicated disease specialty area. Primary responsibilities include verification of insurance benefit eligibility, insurance pre-certification and authorization, verification of prescription benefits, analysis of insurance rejections, and writing payer appeals. This position works with the Centralized Authorization Unit, the Centralized Infusion Unit, and the care team to identify and eliminate barriers to access, reimbursement and affordable care.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

The responsibilities of the Financial Care Coordinator include and are not limited to the following:

* Obtains detailed insurance benefit information for all aspects of infusion treatment care plan
* Computes liability estimates based on gaps in coverage
* Completes administrative functions associated with all prior authorization requirements
* Works with department clinical liaisons for drug grants and programs for inadequately insured patients
* Receives denial and appeal requests and coordinates applicable information and formalizes payer appeals with departmental clinical liaisons
* Manages necessary insurance product needs, including Medicaid and other program enrollment
* Navigates financial aspects of off-label infusion requests, e.g. prior authorizations, waivers, providing treatment estimates and collecting payments
* Work with Centralized Authorization Unit / Non-Oncology Infusion Unit to identify potential payer issues prior to patient visit
* Acts as a key contact to physicians, nurses, care team and patients for insurance questions and all aspects of access to care
* Collaborates with International Office where applicable
* Attends appropriate department and practice meetings

SKILLS/ ABILITIES/COMPETENCIES REQUIRED:

* Must be able to provide excellent customer service
* Ability to communicate effectively and sensitively with patients, their families, and hospital staff
* Must possess excellent organizational and prioritizing skills with the ability to multitask
* Ability to problem solve, work under pressure and under very tight deadlines
* Energetic team player with strong communication and interpersonal skills, positive attitude
* Must have adequate typing skills and be familiar with personal computers
* Bilingual in English and another language a plus

EDUCATION:

* Bachelor's degree, health related field (science, social work, e.g) preferred
* High School diploma required

EXPERIENCE:

* Excellent Customer Service Skills
* 5-7 years work in healthcare environment (preferred)
* Adequate computer, phone and typing skills
* Microsoft Word and Excel (preferred)
* Strong communication, interpersonal, team skills
* Knowledge of third party payers, government programs, insurance regulations, managed care contracting, medical terminology, and clinical considerations related to cancer care
* Knowledge of medical terminology and coding a plus
* Willingness to continually learn and grow as a member of a team and department

The right candidate is trustworthy, has a positive attitude, quick mind, and thrives while working under strict time-lines. We are looking for a fast learner of public third party payer regulations to ensure reimbursement so that MGH can continue to provide the highest quality of care in the industry for some of our most vulnerable citizens. We will gladly train the right candidate.